Friday, July 6, 2012

President Obama won what some observers claim is a significant victory when the Supreme Court narrowly ruled that the Affordable Care Act — “Obamacare” — his signature legislation that expands health insurance coverage, was constitutional and could be implemented by the federal government. Democratic supporters of the president rejoiced at the ruling while Republicans denounced Chief Justice John Roberts for his deciding vote and vowed to redouble their opposition to the law.

But the future of “Obamacare” is not so black-and-white as both proponents and detractors would like to think. The court’s ruling does little to ease the complicated task of implementing health care reform on a national scale, conservative attacks on the law leave it vulnerable to political wrangling that may yet kill it, and tens of millions of uninsured Americans will receive no benefits from a measure touted by the White House as “universal” health care.

The most pressing threat to the immediate future and imminent implementation of the Affordable Care Act comes from the states, who are charged with setting up the framework upon which the law will operate nationally. GOP opposition threatens to stall this even in the wake of the Supreme Court’s ruling, with Florida Gov. Rick Scott featuring as the leading Republican thorn in the side of “Obamacare.”

Gov. Scott made a national name for himself as a grassroots leader attacking the premise of “Obamacare” before it became law, and he carried that opposition over once he became Florida’s governor. Joining the legal fight which precipitated the Supreme Court’s decision, Scott was consistent in stalling any action connected to health care reform in his state but indicated that he would be willing to acquiesce if the court ruled in the law’s favor.

Things have changed less than a week after the ACA was upheld. Now Scott is flip-flopping on his vow to adhere to the court’s verdict and is publicly refusing implement any provisions of health care reform in the state of Florida.

The meat of “Obamacare” is the creation of health care exchanges in the states that allow people to purchase insurance individually and an expansion of Medicaid that, in theory, would cover uninsured residents. Scott says he will not cooperate with the federal government on these measures and that he isn’t “going to implement Obamacare,” a decision that sets up a showdown between Florida and the Obama administration as the law allows federal intervention to make sure ACA provisions are working in every state.

Gov. Rick Scott said late Friday that Florida will not begin implementing the federal health care law because he believes it is bad policy and too costly for Floridians.

Scott told Fox News that he believes the law should be repealed, hopefully by a new president elected in November. But even if that doesn’t happen, he said, Florida will not set up a health exchange or participate in an expansion of the Medicaid program.

“We’re not going to implement Obamacare in Florida,” Scott told Fox News anchor Greta Van Susteren on Friday night. “We’re not going to expand Medicaid because we’re going to do the right thing. We’re not going to do the exchange.”

Scott’s announcement came just hours after he told media that he was still considering his options in the wake of Thursday’s U.S. Supreme Court ruling to uphold the Patient Protection and Affordable Care Act.

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“We care about having a health care safety net for the vulnerable Floridians,” Scott said on Fox. “But this is an expansion that just doesn’t make any sense.”

Scott’s stand against the federal government is being criticized by many in the state, and has met with a lukewarm reception from his fellow Republican lawmakers.

Supporters of health care reform say it will create thousands of new jobs through expansion of medical services and the influx of federal dollars into the state. 100 percent of ACA expenses would be covered by federal money rather than money from the state or its taxpayers. Also at play is insurance coverage for half-a-million Florida chldren that currently lack it.

Even Republicans in the state legislature have distanced themselves from Scott’s hasty decision to fight “Obamacare,” saying that “it has been upheld by the court” and the state should figure out ways to implement it rather than ceding authority to the federal government.

The stakes are high in the Sunshine State’s partisan tussle over health care. Florida ranks near the top i the percentage of residents without health insurance, as well as the raw numbers of people without insurance. It is saddled with the largest number of uninsured among those states whose governors have publicly said they will not cooperate with the ACA.

Between Gov. Scott’s stand against health care reform and the holes in coverage inherent with the law itself, little help appears to be coming for the nearly 4 million state residents without health insurance, a number that has surged by 1 million since the year 2000.

The number of uninsured Floridians has grown by more than 1 million in the last decade according to data released Tuesday by the U.S. Census Bureau, writes Kim MacQueen of the Florida Current.

As Florida grew between 2000 and 2010 so did the number of those who were not covered by either government or private health insurance.

Florida’s population grew from 16 million to 18.5 million in the last ten years, but the same time period saw a swelling in the ranks of those who had no health insurance coverage as well as growth in the number of people enrolled in Medicaid. Medicaid is a state-federal funded health insurance program. The latest estimates show that there are 3.8 million without health insurance.

Florida currently has the fifth-highest percentage of uninsured in the nation with a rate of just under 21 percent, behind Texas, New Mexico, Nevada and Mississippi. But both Nevada and Mississippi were behind Florida until 2010.

The partisan mess in Florida and a handful of other states even after the Supreme Court deemed it constitutional has uncovered the many flaws built in to the details of the president’s health care achievement.

Even aside from the obvious threats to the Affordable Care Act’s existence from the very real possibility of a Republican sweep of the House, the Senate and the presidency this November — a trio of GOP successes that they promise will have the law dead by the end of next January — power vested in states and their elected officials to decided whether or not to adopt the measure ensures gridlock and delay in implementation.

Like Rick Scott in Florida, Medicaid expansion as the backbone of providing insurance to only about half of those currently without coverage gives significant authority to states on how and whether to comply with these changes to a state-based program.

Twenty-six states joined the legal fight to overturn “Obamacare,” leading to the possibility that an identical number could emulate Florida, Louisiana and other states governed by conservative Republican opponents of the law in simply ignoring it, wiping away the only lasting impact of the ACA and cutting down even further on the number of uninsured it actually covers.

The Affordable Care Act didn’t survive entirely as passed—somewhat lost amidst the intense focus on the individual mandate was a ruling that part of the law’s Medicaid expansion was unconstitutional. The Supreme Court’s modification of the law probably won’t have a fundamental, long-term impact, but does make it easier for rogue Republican governors to exempt their states from participating in the expansion—and could cost millions of low-income, uninsured Americans a chance at government health care.

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But the question is whether in the short-term, red-state governors will slide through the crack opened by the Supreme Court to pull out of the expansion, as the Republican Party still finds it politically valuable to fulminate and rebel against the dreaded Obamacare.

The stakes here are not small. A ProPublica analysis of an Urban Institute study found the twenty-six states that sued the federal government contain 8.5 million uninsured people who would be covered under the expansion—more than half of the total number expected to benefit.

Even with full cooperation from the states and a fully functioning law, the idea pushed by the White House and their supporters that “Obamacare” is somehow “universal” health care is false.

This flawed vision of health care reform that relies on a convoluted system of state exchanges and Medicaid expansion vulnerable to political attack only manages to cover a little more than half of Americans lacking health insurance coverage right now, leaving around 26 million people uninsured.

One of the biggest misconceptions about President Obama’s health care overhaul isn’t who the law will cover, but rather who it won’t.

If it survives Supreme court scrutiny, the landmark overhaul will expand coverage to about 30 million uninsured people, according to government figures. But an estimated 26 million Americans will remain without coverage — a population that’s roughly the size of Texas and includes illegal immigrants and those who can’t afford to pay out-of-pocket for health insurance.

“Many people think that this health care law is going to cover everyone, and it’s not,” says Nicole Lamoureux, executive director of the Alexandria, Va.-based National Association of Free & Charitable Clinics, which represents about 1,200 clinics nationally.